PNEUMOTHORAX

A B B D E F G And K L M N O U R C T Y P X C H W E I

PNEUMOTHORAX - accumulation of air in the pleural cavity due to light of leakage or damage to the chest wall. If the air flow into the pleural cavity is quickly terminated as a result of the closure of the defect in the parenchyma of the lung or chest wall, called a pneumothorax closed. If the air has penetrated the pleural cavity, freely communicates with the atmospheric through a hole in the chest wall, pneumothorax is called open. In cases when during inhalation air is sucked into the pleural cavity, and during exhalation can not get out of it because of the closure (wears off) the defect arises valve (strained, valve) pneumothorax. Depending on the cause of distinguish spontaneous, traumatic and artificial pneumothorax.

Spontaneous pneumothorax is usually secondary, and occurs in a variety of pathological processes in the lungs - bullous emphysema, chronic obstructive pulmonary diseases (chronic bronchitis, bronchial asthma), lesions of the lung in tuberculosis, histiocytosis X, pneumoconioses (eg silicotuberculosis, berylliosis), systemic diseases of connective tissue ., fibrosing alveolitis, etc. The cause of spontaneous pneumothorax in newborns can be pneumopathy accompanied by the development of respiratory distress syndrome; rupture of the alveoli and the visceral pleura as a result of a sharp rise in pressure during intrabronchial manipulation conducted with newborn asphyxia (tracheal intubation followed by mechanical ventilation, etc.). In older children, to the emergence of spontaneous pneumothorax can result in increasing intrabronchial pressure with whooping cough, foreign body aspiration. One of the most common causes of spontaneous pneumothorax in children of the first years of life is the gap subpleural cavities or superficial microabscesses with destructive pneumonia predominantly staphylococcal etiology.

Congenital lung cysts air tight and localized congenital emphysema in children may also be complicated by pneumothorax. In those cases where the nature of pneumothorax is unknown, it regarded as the primary (idiopathic) spontaneous.

Spontaneous pneumothorax can occur both during exercise, coughing, and at rest. The main symptoms are sudden chest pain on the affected side, feeling short of breath, shortness of breath , sometimes a dry hacking cough . There are cyanosis , tachycardia , rarely - a drop in blood pressure. Seen from the lagging behind of one of the halves of the chest when breathing. In young children sometimes marked bulging of the affected half of the thorax. On the side of the lesion is not determined by palpation voice trembling, determined boxed percussion sound (with extensive pneumothorax - tympanitis), breath sounds weakened or is not listening. The final diagnosis was set at X-ray examination (reveal accumulation of gas in the pleural cavity and accordingly spadenie lung tissue and mediastinum displacement of bodies in a healthy way). The clinical picture of secondary spontaneous pneumothorax is more severe since not only due to its development, but also the underlying disease. When you break a lung abscess or tuberculous cavity, the formation of the valve pneumothorax.

A patient with symptoms of spontaneous pneumothorax should be immediately taken to the surgical hospital (accompanied by a paramedic). Prehospital anesthesia is administered for the purpose of analgin, with pronounced pain morphine, omnopon; conduct oxygen therapy. In order to suppress the cough reflex are using codeine, libeksin, tusupreks. In the case of the progressive deterioration of the patient's condition (increase in shortness of breath, a sharp drop in blood pressure, etc.), Due to valve pneumothorax, pleural urgent need to make a puncture in the second intercostal space on the midclavicular line (in the absence of a doctor this manipulation can produce a paramedic). The needle is fixed and is left in that position during shipment.

At the hospital the doctor produces pleural puncture (if it has not been done before), followed by air aspiration. If you can not straighten light punctured the pleural cavity using a trocar and implement continuous aspiration through drainage. Further treatment is determined by the underlying disease. To prevent a recurrence of spontaneous pneumothorax using sclerotherapy in the pleural cavity with a view to its obliteration and the formation of adhesions (pleurodesis) introduced irritating drugs. An effective diagnostic and treatment method is thoracoscopy (plevroskopiya), which allows to establish the cause of pneumothorax and perform a series of medical manipulations: electrocoagulation, adhesive applique vent, etc. In patients with multiply recurrent spontaneous pneumothorax may be indications for radical surgery - pleurectomy or lung resection.. Surgical treatment is also used in pneumothorax complicating congenital malformation of the lung (eg, congenital cysts air). The prognosis for spontaneous pneumothorax, if treatment is initiated in a timely manner, is generally favorable.

Traumatic pneumothorax occurs when the mechanical damage of the chest, bronchus or lung, including the wounds. Sometimes, especially in children, traumatic pneumothorax is a complication of a variety of medical procedures. Thus, it may be due to damage to the lung puncture or catheterization of the subclavian vein, pleural puncture, during bronchoscopy, accompanied by a variety of manipulation (removal of foreign body bronchial biopsy, and others.). Sometimes pneumothorax occurs as a result of damage to the esophagus during esophagoscopy. Closed traumatic pneumothorax develops, if the air flow in the pleural cavity of the chest wall through a wound or damaged bronchi was short-lived. Clinical manifestations are similar to those in spontaneous pneumothorax. With a small accumulation of air in the pleural cavity of the clinical symptoms of poorly expressed. Closed pneumothorax is characterized by the accumulation in the pleural cavity of a significant amount of air ventilation causes serious disorders due to atelectasis and mediastinal organs bias. Sometimes the patient's condition is serious due to intrapleural bleeding.

Outdoor traumatic pneumothorax occurs in the presence of wound hole in the chest wall through which the pleural cavity communicates freely with the external environment, the air being sucked in during inhalation pleural cavity, and extends outwardly during exhalation. In this case, the patient's condition is severe, due to atelectasis and off it from the act of breathing, as well as a shift of the mediastinum to the healthy side and moving it with every breath and exhale (flotation mediastinum). With an open pneumothorax marked cyanosis , shortness of breath , sometimes up to 40 - 50 breaths in 1 minute. Pulse is speeded up, weak filling, blood pressure is reduced. When coughing blood from the wound flows with air bubbles. When X-ray to identify pleural air and in most cases the level of liquid - gemopnevmotoraks, and in the absence of pleural adhesions - complete atelectasis.

With a small, half-soft tissue injury of the chest wall, and with closed chest trauma valve pneumothorax can occur with lung injury. Intrapleural pressure in the case exceeds atmospheric. Mediastinal shift leads to a significant disruption of blood circulation and lung compression - to the drastic difficulty breathing. The patient's condition at the valve pneumothorax is extremely difficult, there was a sharp dyspnea , cyanosis of the face, increased heart rate, increasing subcutaneous emphysema in the chest, back, neck, face, abdomen and sometimes the limbs. X-ray revealed a massive accumulation of air in the pleural cavity, atelectasis, mediastinal shift to the opposite side of the authorities, the gas layers in the tissues of the mediastinum, chest wall, neck, etc.

The victim with traumatic pneumothorax must be urgently taken to the hospital, accompanied by a paramedic. In closed pneumothorax in the case of a minor accumulation of air in the pleural cavity of urgent remedial measures are not required; when a cluster of large amounts of air in the pleural cavity, caused the complete atelectasis, shows the air evacuation of the pleural cavity with pleural puncture.

With an open pneumothorax first aid is immediately applied to the wound of the chest hermetic (occlusive) dressings using plaster or oilcloth lining of the individual package, which is fixed to the edges of the wound with glue and gauze (bintovoy) bandage. Wounded necessary to provide oxygen inhalation anesthetics enter (morphine et al.), Antibiotics. In the hospital debridement produce a sealing defect of the chest wall by layered suturing or plastic surrounding tissues.

When the valve pneumothorax, open outwards, the wound of the chest wall impose an airtight bandage of plaster and transported the patient to the hospital. If the valve is opened inwards pneumothorax (a defect of the chest wall is not), shows the urgent pleural puncture in the second intercostal space on the midclavicular line and leaving a thick needle into the pleural space during transport to hospital.

The hospital produced thoracostomy constant active aspiration, and if you can not last - drainage for Bulan, Hautes-Pyrénées. It is necessary to carefully monitor the drainage, daily change antiseptic solution, which lowered the free end of the drainage. With significant damage to lung tissue, inability to spread easily through aspiration or drainage, as well as produce intrapleural bleeding thoracotomy, revision or treatment of lung tissue (bronchial), its seal. Sometimes needed resection of the affected part of the lung.